Tongue-tie & Structure
These presentations focus on the assessment, diagnosis and treatment of tongue-tie and other structural issues that have a negative impact on normal infant sucking skills and development.
A Breastfeeding-friendly Approach to Tongue-tie
Dr. Yvonne LeFort has been a family physician for over 25 years and is based in Auckland New Zealand. She is a graduate of Dalhousie Medical School and University of Calgary Family Medicine in Canada. She is a Fellow of the Academy of Breastfeeding Medicine since 2013.
She has been involved in helping breastfeeding mothers and babies for 18 years. Her specific interest in tongue tie and its management was nurtured through her association with Dr. Evelyn Jain who was a true pioneer in the recognition of the importance of breastfeeding and the impact that untreated ankyloglossia can cause on the breastfeeding experience.
Dr. LeFort has established a private Breastfeeding Clinic in Auckland New Zealand providing comprehensive lactation care for mothers and their infants. Her service includes the management of tongue tie and involves a lactation consultant for parallel breastfeeding support.
Great interest has resulted from discussions and blogs concerning tongue-tie which have not always appeared to be mindful the research and evidence of the past 20 years. Much of the basic clinical management of the tongue tied breastfeeding infant and mother has evaporated from these discussions quite inappropriately. I would like to bring us back to the basics of this issue and remind us of what evidence does and does not exist.
The management of any breastfeeding issue remains the realm of the lactation consultant and tongue tie is no exception. Unlike a true stand alone surgical condition, the management of tongue tie requires pre-operative assessment and post-operative strategies to primarily protect the breastfeeding relationship thereby optimizing outcomes. The key guiding factor must be “primum non nocere” – first do no harm – to the breastfeeding relationship. Case studies will be shared that demonstrate the approach taken by the clinician and lactation consultant. Appropriate management and outcomes will be discussed.
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A Sensory Motor Approach to Neuromuscular Re-Education Post Frenotomy
This session will focus on functional assessment and treatment of tethered oral tissue in the breastfeeding infant. Participants will understand the importance of task analysis of the motor skills to support sucking, prior to referring an infant for a release. Post op treatment has focused on active wound management (Ghaheri, B. 2017) rather than neuromuscular re-education. This approach multidisciplinary approach encourages lactation consultants to partner with body works specialists and speech pathologists to develop the underlying motor skills to support sucking.
Aerophagia Induced Reflux Associated With Lip and Tongue Tie in Breastfeeding Infants
Dr. Siegel is a pioneering Tongue Tie surgeon, mentored through medical school, residency and in private by practice by the late Elizabeth Coryllos, MD. He is a dual degree MD, DDS Oral and Maxillofacial Surgeon, lectures internationally and publishes on the topic of Reflux associated with Lip and Tongue Ties.
This study aims to show a correlation between aerophagia in infants with tethered oral tissues (TOT’s) consisting of ankyloglossia and shortened maxillary labial frenula (tongue and lip-tie) and reflux. Currently there is little to no data on aerophagia as a possible cause of reflux in infants. Infants with tongue and possibly lip tie often have a poor latch in which there is often an inadequate seal around the breast and inefficient transfer of milk. As a result many of these infants swallow air during breastfeeding. Many of these infants suffer from symptoms of reflux. This study and results to demonstrate a correlation of ankyloglossia and shortened maxillary labial frenula with aerophagia and reflux.Treatment of these infants with a relatively simple frentomy procedure may reduce or eliminate reflux in this population.
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Dr. Brandi is the pediatric chiropractor in a practice that provides chiropractic care for women and children. Her focus is on infants with feeding difficulties and children with neurodevelopmental delays. Dr. Brandi created a program at her practice which incorporates chiropractic, optimal nutrition, myofascial/cranial-sacral techniques, and neurofunctional exercises into one comprehensive program. Her ultimate goal is to naturally support the body (brain, gut, spine and immune system) to work together in balance and help children achieve their maximum life potential. Dr. Brandi attended Cleveland Chiropractic College after earning a bachelor’s degree from the University of Missouri- Kansas City. She is also certified by the Academy of Chiropractic Family Practice. In her free time, Dr. Brandi enjoys spending time outdoors with her husband and two sets of fraternal twins.
Oral ties are often diagnosed and released during infancy to improve the breastfeeding relationship between mother and baby. But what happens if ties go undiagnosed? This course will review tethered oral tissues and their relationship in a breastfeeding dyad and the neurodevelopment of an infant and beyond. We will explore the implications of oral restrictions on the myofascial system throughout the body. Movement patterns, posture, and primitive reflex integration can all be affected by oral ties. Signs, symptoms, assessment tools, and strategies for co-management between IBCLC and bodyworkers will be discussed. Attendees will also learn neuro-biomechanical implications of TOTs beyond breastfeeding. Several case studies will be discussed and how successful management can be achieved with a team approach.
Ankyloglossia – Recognition of the many different forms & Impact on Breastfeeding and Lifelong Health
James G. Murphy, MD, is a private practice pediatrician specializing in Breastfeeding Medicine. He was formerly an Assistant Professor of Pediatrics at the F. Edward Hérbert School of Medicine, Uniformed Services University of the Health Sciences. He served 25 years active duty as a physician with the US Navy, 12 years as a contract pediatrician with the US Navy and 6 years as a Government Service Medical Officer at the Naval Medical Center in San Diego, CA. He is a Fellow of the American Academy of Pediatrics, a Fellow of the Academy of Breastfeeding Medicine, Vice President of the San Diego County Breastfeeding Coalition, a member of ILCA and, since 2009, an IBCLC. Dr Murphy began performing lingual frenulotomies in Oct 2003 and has performed over 2800 of these procedures to date including posterior sub-mucosal fibrous bands and 300 Upper Lip Tie releases.
The concept of Tongue Tie has changed as expertise in the recognition and management of this entity has expanded. Also the consequences of not recognizing and effectively managing this entity and the “Faux Ties” which mimic it are many and expanding as data is collected to document the relationship. Breastfeeding is the most obvious and most severely affected function in infancy. Additional problems become apparent as the infant grows and develops into an ever more complicated organism. This presentation will discuss the many variations of tongue anatomy which present as a Tongue Tie, how to recognize each of these and the consequences of not managing this problem effectively in early infancy.
Biomechanics of milk extraction during breast-feeding
David Elad is a Professor of Biomedical Engineering at Tel Aviv University since 1985. He received his B.Sc. in Mechanical Engineering on 1973, M.Sc. and D.Sc. in Biomedical Engineering on 1978 and 1982, all from the Technion, Haifa, Israel. He was then awarded the Rothschild and Bantrell post-doctoral fellowships at Imperial College London and M.I.T.
David pioneered computational studies of biofluid transport phenomena in the nasal cavity in the late 80's. In the early 90's he established a comprehensive research program in bioengineering of human reproduction, both at Tel Aviv University. He developed his expertise in the fields of Respiratory Biomechanics and Reproductive Bioengineering, from complete organs all the way to the cellular levels. The respiratory studies included integrative assessment of respiratory muscles, transport phenomena in the human nose, objective noninvasive evaluation of nasal function and mechano-transduction of nasal epithelial cells cultured under air-liquid interface conditions, including effects of air-pollution. The reproductive studies included the role of uterine peristalsis in early human life, pre-implantation embryo transport after IVF, feto-maternal blood circulations in the placenta, transport of nutrition, pharmaceuticals and carcinogenic materials across a tissue engineered placental barrier, mechano-transduction of cultured ovarian cancer cells and biomechanics of infant breastfeeding. He published over 120 articles in peer-review journals and was the leading editor of 5 special journal issues in reproductive bioengineering, respiratory biomechanics and biofluid mechanics.
David has been a visiting scholar at Imperial College London, Massachusetts Institute of Technology, Northwestern University, Nagoya Institute of Technology, Drexel University, Georgia Institute of Technology, University of Toronto, City College New York and Columbia University. He is a member of the World Council for Biomechanics (2002-14) and a fellow of the American Institute for Medical and Biological Engineering (2004), the Biomedical Engineering Society, USA (2005) and the International Academy of Medical and Biological Engineering (2013).
Dr. Elad is currently on sabbatical leave from Tel Aviv University and affiliated with the Department of Biomedical Engineering of Columbia University.
The physical mechanisms executed by the infant during breastfeeding have been intriguing topics that lead to a long scientific controversy; whether it is sucking of the milk or mouthing of the nipple/areola. We developed a dynamic analysis of ultrasound video clips acquired during breastfeeding in order to explore the kinematics of the tongue. Then, we have developed a three-dimensional biophysical model of the breast and lactiferous tubes that enabled mimicking latch-on and the dynamic characteristics of the tongue and nipple observed in ultrasound imaging during breastfeeding. Then, we simulated breastfeeding and explored the biomechanical aspects of breastfeeding. We demonstrated that latch-on to draw the nipple/areola into the infant mouth, as well as milk extraction during breastfeeding, require development of time varying sub-atmospheric pressures within the infant's oral cavity. Analysis of infant tongue motility was compared between breast and bottle feeding. The presentation will also include discussion of oral pressure measurements.
Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study
Bobby Ghaheri, MD is a board certified ear, nose and throat specialist with The Oregon Clinic in Portland, OR. His interest in treating children with tongue and lip-tie stems from his ardent support of breastfeeding and was furthered by his personal experiences, as his youngest child benefited from treatment for it. He enjoys working with children and has an interest in traditional and non-traditional approaches to pediatric pain control. To communicate with him, feel free to email him at drghaheri@gmail.com or follow him on Twitter at @DrGhaheri.
Topic: Diagnosis and Management of Tongue Tie and Lip Tie in Breastfeeding - [View Abstract]
Surgical release of tongue/lip-tie results in significant improvement in breastfeeding outcomes. Improvements occur early (1-week postoperatively) and continue to improve through 1-month postoperatively. Improvements were demonstrated in both infants with classic anterior tongue-tie and less obvious posterior tongue-tie. This study identifies a previously under-recognized patient population that may benefit from surgical intervention if abnormal breastfeeding symptoms exist.
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Comprehensive Review of Laser Soft Tissues Physics Infant Lip and Tongue Frenum Surgery
Dr. Martin Kaplan was born in Chelsea, Ma. He completed his undergraduate degree at The University of Massachusetts and then attended Tufts University School of Dental Medicine. After earning his D.M.D. degree he completed a pediatric residency at Montefiore Hospital in New York.
Dr. Kaplan practices exclusively in Stoughton, MA. He continues to take update his laser education by regularly attending the Academy of Laser dentistry Annual meeting where is also contributes as a lecturer ans laser safety officer. He is one of only a handful of pediatric laser dentists who utilizes lasers for the treatment of infants with breastfeeding issues related to frenum attachment problems.
He is a member of the:
• American Academy of Pediatric Dentistry
• Massachusetts Academy of Pediatric Dentistry
• American Dental Association
• Massachusetts Dental Society
• Academy of Sports Dentistry
• Academy of Laser Dentistry
Academy of Breastfeeding Medicine
When not practicing dentistry he enjoys Karate and has attained the level of 4th degree black belt.
Topic: Infant Frenotomy for the Clinician - [View Abstract]
Topic: Lip and Tongue-tie: Fad or Lifelong Health Issue? - [View Abstract]
There will be an explanation of the science of laser physics that is easily understandable as it applies to the selection of proper types of lasers. There currently are 3 main wavelengths that can be used for laser surgery. An explanation of how these wavelengths are applicable and how they determine outcomes for infant tissue interaction for laser surgery will be presented in a slide presentation and through videos. The physics of lasers will then be translated to clinical reality through the presentation of various clinical cases which will allow the group to better understand how they can interpret post-surgical results and how the various lasers do interact differently. The tissue healing process of the tissue with the laser wavelengths will also be reviewed and related to the active wound management methods that are suggested. There will be a review of assessment for how the provider of laser surgery selects the setting for his applications in surgery. Through the entire presentation, multiple slides will effectively clarify the mystery behind the true science of the laser surgeries which our patients are receiving.
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Diagnosis and Management of Tongue Tie and Lip Tie in Breastfeeding
Bobby Ghaheri, MD is a board certified ear, nose and throat specialist with The Oregon Clinic in Portland, OR. His interest in treating children with tongue and lip-tie stems from his ardent support of breastfeeding and was furthered by his personal experiences, as his youngest child benefited from treatment for it. He enjoys working with children and has an interest in traditional and non-traditional approaches to pediatric pain control. To communicate with him, feel free to email him at drghaheri@gmail.com or follow him on Twitter at @DrGhaheri.
Topic: Diagnosis and Management of Tongue Tie and Lip Tie in Breastfeeding - [View Abstract]
While most breastfeeding problems can be managed effectively by a lactation consultant, situations arise where conservative interventions are ineffective in improving symptoms of a poor latch. Infant symptoms (aerophagia, poor weight gain, falling asleep prematurely, or frustration at the breast) or mother's symptoms (pain, engorgement, nipple damage) can often be explained by tongue-tie or lip-tie. I will explain effective diagnostic strategies and surgical interventions (scissors vs laser) in addressing these problems.
Foundations of TOTS Assessment: Anatomy, Appearance, and Function
Lisa Lahey RN, IBCLC, OMT has worked for 23 years in maternal child health as a nurse and lactation consultant in L/D, postpartum, newborn nursery, NICU, and perinatal education. Lisa is currently working on her master's degree for Family Nurse Practitioner. An IBCLC for 20 years, Lisa has a special interest and expertise in tethered oral tissues. Lisa’s private practice Advanced Breastfeeding Care provides home visits or office consults for complex feeding issues as well as joyful breastfeeding. Lisa also provides myofunctional therapy to babies, children, and adults in a functional orthodontic office. Lisa is a contributing author to the book Tongue Tied. Lisa enjoys teaching assessment fundamentals and oral exercises when she lectures at conferences and courses. Clinical photography and nature photos are also a favorite hobby. Most of all, she is a mom to five children (all were breastfed) who keep her busy and remind her daily of life’s joys and treasures traveling and hiking with her family to unplug from a busy pace in life.
Topic: Utilizing Myofunctional Methods and Lactation Therapy Pre & Post Frenectomy for Optimal Suck Rehabilitation - [View Abstract]
The IBCLC must develop and expand knowledge of the 3 foundations key to TOTs assessment which are anatomy, appearance, and function. This talk will review anatomy and physiology concepts, explore appearance of frenulums, and discuss current functional screening tools that can be utilized for assessment.
